Warming device for perioperative use

ABSTRACT

A warming device for perioperative use includes a clinical garment and a convective thermal blanket supported on an inside surface of the clinical garment. A mechanism may be provided to releasably attach the thermal blanket to the clinical garment.

RELATED APPLICATIONS

This application contains subject matter related to the subject matterof the following patent applications, all commonly owned herewith:

Patent Cooperation Treaty (PCT) Application No. PCT/US2003/11128, filedApr. 10, 2003, entitled “Patient Comfort Apparatus and System”, andpublished on Oct. 23, 2003 under Publication No. WO 2003/086500;

Patent Cooperation Treaty (PCT) Application No. PCT/US2005/025355, filedJul. 18, 2005, entitled “Perioperative Warming Device”, and published onFeb. 23, 2006 under Publication No. WO 2006/020170;

Patent Cooperation Treaty (PCT) Application No. PCT/US2005/043968, filedDec. 6, 2005, entitled “Warming Device with Varied Permeability”, andpublished on Jun. 15, 2006 under Publication No. WO 2006/062910;

Patent Cooperation Treaty (PCT) Application No. PCT/US2005/044214, filedDec. 6, 2005, entitled “Warming Device”, and published on Jun. 15, 2006under Publication No. WO 2006/063027;

Patent Cooperation Treaty (PCT) Application No. PCT/US2006/004644, filedFeb. 9, 2006, entitled “Warming Device for Perioperative Use”, andpublished on Aug. 17, 2006 under Publication No. WO2006/086587;

PCT Application No. PCT/US2006/041028, filed Oct. 19, 2006, entitled“Multifunction Warming Device for Perioperative Use”, and published onApr. 26, 2007 under Publication No. WO 2007/047917;

PCT Application No. PCT/US2007/013073, filed Jun. 1, 2007, entitled“Warming Device”, and published on Jan. 31, 2008 under Publication No.WO2008/013603;

PCT Application No. PCT/US2008/000141, filed Jan. 4, 2008, entitled“Convective Warming Device With a Drape” and published on Jul. 31, 2008under Publication No. WO 2008/091486;

U.S. patent application Ser. No. 10/411,865, filed Apr. 10, 2003,entitled “Patient Comfort Apparatus and System” and published on Oct.16, 2003 under Publication No. US 2003/0195596, now U.S. Pat. No.7,001,416;

U.S. patent application Ser. No. 10/508,319, 371(c) date Mar. 3, 2005,entitled “Patient Comfort Apparatus and System” and published on Jun.30, 2005 under Publication No. US 2005/0143796;

U.S. patent application Ser. No. 10/895,672, filed Jul. 21, 2004,entitled “Perioperative Warming Device”, now abandoned, published onJan. 20, 2005, under Publication No. US 2005/0015127;

U.S. patent application Ser. No. 11/005,883, filed Dec. 7, 2004,entitled “Warming Device with Varied Permeability” and published on Jun.8, 2006 under Publication No. US 2006/0122671, now U.S. Pat. No.7,226,454;

U.S. patent application Ser. No. 11/006,491, filed Dec. 7, 2004,entitled “Warming Device” and published on Jun. 8, 2006 underPublication No. US 2006/0122672, now U.S. Pat. No. 7,364,584;

U.S. patent application Ser. No. 11/057,396, filed Feb. 11, 2005,entitled “Perioperative Warming Device”, and published on Aug. 17, 2006under Publication No. US 2006/0184215, now U.S. Pat. No. 7,276,076;

U.S. patent application Ser. No. 11/057,397, filed Feb. 11, 2005,entitled “Thermal Blanket for Warming the Limbs,” published on Aug. 17,2006 under Publication No. US 2006/0184216;

U.S. patent application Ser. No. 11/057,404, filed Feb. 11, 2005,entitled “Clinical Garment for Comfort Warming and Prewarming,”published on Aug. 17, 2006 under Publication No. US 2006/0184218;

U.S. patent application Ser. No. 11/260,706, filed Oct. 27, 2005,entitled “Patient Comfort Apparatus and System”, and published on Mar.9, 2006 under Publication No. US 2006/0052853;

U.S. patent application Ser. No. 11/363,136, filed Feb. 27, 2006,entitled “Forced Air Warming Unit” and published on Jul. 6, 2006 underPublication No. US 2006/0147320;

U.S. patent application Ser. No. 11/492,425, filed Jul. 25, 2006,entitled “Warming Device”, and published on Nov. 16, 2006 underPublication No. US 2006/0259104;

U.S. patent application Ser. No. 11/583,432, filed Oct. 19, 2006,entitled “Multifunction Warming Device for Perioperative Use”, andpublished on Apr. 26, 2007 under Publication No. US 2007/0093882;

U.S. patent application Ser. No. 11/583,477, filed Oct. 19, 2006,entitled “Multifunction Warming Device with Provision for BeingSecured”, and published on Apr. 26, 2007 under Publication No. US2007/0093883;

U.S. patent application Ser. No. 11/583,480, filed Oct. 19, 2006,entitled “Multifunction Warming Device with Provision for WarmingHands”, and published on Apr. 26, 2007 under Publication No. US2007/0093884;

U.S. patent application Ser. No. 11/583,481, filed Oct. 19, 2006,entitled “Multifunction Warming Device with an Upper Body ConvectiveApparatus”, and published on Apr. 26, 2007 under Publication No. US2007/0093885;

U.S. patent application Ser. No. 11/656,777, filed Jan. 23, 2007,entitled “Convective Warming Device With a Drape”;

U.S. patent application Ser. No. 11/704,547, filed Feb. 9, 2007,entitled “A Forced Air Warming Unit”;

U.S. patent application Ser. No. 11/801,292, filed May 9, 2007, entitled“Warming Device with Varied Permeability”, and published on Oct. 11,2007 under Publication No. US 2007/0239239;

U.S. patent application Ser. No. 11/899,872, filed Sep. 7, 2007,entitled “Perioperative Warming Method”, and published on Jan. 31, 2008under Publication No. US 2008/0027522; and,

U.S. patent application Ser. No. 11/899,928, filed Sep. 7, 2007,entitled “Perioperative Warming Device”, and published on Jan. 31, 2008under Publication No. US 2008/0027521.

BACKGROUND OF THE INVENTION

A warming device for perioperative use includes a clinical garment withone or more convective thermal blankets supported on the inside of thegarment.

Convective devices that transfer heat to a human body are known. Forexample, there are devices that receive a stream of pressurized, warmedair, inflate in response to the pressurized air, distribute the warmedair within a pneumatic structure, and emit the warmed air onto a body toaccomplish such objectives as increasing comfort, reducing shivering,and treating or preventing hypothermia. These devices are typicallycalled “convective thermal blankets” or “covers”; for convenience, inthis discussion and the following specification, they shall be called,simply, “thermal blankets.” Arizant Healthcare Inc., the assignee ofthis application, makes and sells such devices under the BAIR HUGGER®brand. One such device is the Model 522 Upper Body Blanket.

Use of the term “convective” to denote the transfer of heat between thewarming device and a body refers to the principal mode of heat transfer,it being understood that heat may at the same time be transferredbetween a warming device and a body by conduction and radiation,although not to the degree of convection.

A recent invention disclosed in the referenced PCT application adapts aclinical garment such as a robe or gown to receive a convective devicein order to warm a person wearing the garment in a clinical setting forcomfort and mobility of the person. There is a need to further adaptsuch a combination for use perioperatively.

The term “perioperative” is defined in the PDR Medical Dictionary,Second Edition, (Medical Economics Company, 2000), as “around the timeof operation.” The perioperative period is characterized by a sequenceincluding the time preceding an operation when a patient is beingprepared for surgery (“the preoperative period”), followed by the timespent in surgery (“the intraoperative period”), and by the timefollowing an operation when the patient is closely monitored forcomplications while recovering from the effects of anesthesia (“thepostoperative period”).

According to Mahoney et al. (Maintaining intraoperative normothermia: Ameta-analysis of outcomes with costs. AANA Journal. 4/99; 67,2:155-164.), therapeutic warming is employed during at least theintraoperative period in order to prevent or mitigate a constellation ofeffects that result from hypothermia. In fact, it is increasinglymanifest that maintenance of normothermia perioperatively enhances theprospects for a quick, successful recovery from surgery. Theeffectiveness of therapeutic warming depends upon delivery of enoughheat to a patient's body to raise the patient's core body temperatureto, or maintain it within, a narrow range, typically near 37° C. Thisrange is called “normothermic” and a body with a core temperature inthis range is at “normothermia.” Hypothermia occurs when the core bodytemperature falls below 36° C.; mild hypothermia occurs when core bodytemperature is in the range of 34° C. to 36° C. Therefore,“perioperative therapeutic warming” is warming therapy capable of beingdelivered during one or more of the perioperative periods for theprevention or treatment of hypothermia.

Therapeutic warming is contrasted with “comfort warming” which isintended to maintain or enhance a patient's sense of “thermal comfort”.Of course, therapeutic warming may also comfort a patient by alleviatingshivering or a feeling of being cold, but this is a secondary orancillary effect. Thermal comfort is a subjective notion; however, theenvironmental conditions necessary to produce a sense of thermal comfortin a population of human beings are known and well tabulated. Forexample, Fanger (Thermal Comfort: Analysis and Applications ofEnvironmental Engineering. Danish Technical press, Copenhagen, 1970)defines thermal comfort as “that condition of mind which expressessatisfaction with the thermal environment.” Even when a patient isnormothermic, less than ideal environmental conditions can result inacute feelings of discomfort. Under normothermic conditions, thermalcomfort is largely determined with reference to skin temperature, notcore body temperature. Comfort warming is warming applied to a patientto alleviate the patient's sense of thermal discomfort.

Therapeutic warming may be indicated during any one or more of theperioperative periods. For example, for a short operation in a surgerywith no warming equipment available, a person may be warmedpreoperatively in a preparation area to raise mean body temperature to alevel higher than normal in order to store enough thermal energy tomaintain normothermia, without heating, intraoperatively. After surgery,it may be necessary to apply therapeutic warming in a recovery area toraise the core temperature to normothermia and maintain it there for aperiod of time while anesthesia wears off. Alternatively, for a longsurgery in an arena with heating equipment available, a person may bewarmed for comfort before surgery and warmed therapeutically during andafter surgery.

Both therapeutic warming and comfort warming may be provided byconvective devices such as convective thermal blankets that receive anddistribute warmed, pressurized air and then expel the distributed airthrough one or more surfaces toward a patient in order to prevent ortreat hypothermia in the patient. An example of use of such a device fortherapeutic warming is found in U.S. Pat. No. 6,524,332, “System andMethod for Warming a Person to Prevent or Treat Hypothermia”, commonlyowned with this application. Comfort warming by convective means isdescribed in the referenced U.S. Patent Application, and the referencedPublication No. WO 03/086500.

When delivered by convective devices, therapeutic warming isdistinguished from comfort warming by intended effects and by theparameters of heat delivery that produce those effects. In this regard,a convective warming system typically includes a source of warmedpressurized air (also called a heater/blower unit, a forced air warmingunit, a heater unit, etc.), a convective device such as a thermalblanket (which is, typically, inflatable), and a flexible conduit or airhose connecting the heater/blower unit with the thermal blanket. Use ofsuch a system for a particular type of warming requires delivery ofwarmed air through a thermal blanket at parametric values that achieve aparticular objective. The conditions by which a convective device suchas a thermal blanket produces thermal comfort in normothermicindividuals at steady state are significantly different from thosenecessary to treat hypothermia. Typically the conditions for thermalcomfort are met in a system with a relatively low capacity heater/blowerunit, while those in a therapeutic warming system are achieved with arelatively high capacity heater/blower unit. The different capacitieshave led to use of air hoses with different capacities, with thosedelivering air flow for thermal comfort typically having smallerdiameters than those serving a therapeutic warming requirement. Theresult is a divergence of designs leading to installation of differentair delivery infrastructures for therapeutic and comfort warming.

Health care cost is an issue of national importance. The cost of warmingperioperatively is directly related to the number of perioperativeperiods in which a person is warmed; the cost increases when differentwarming apparatus are used in different periods to accomplish differentgoals. For example, when comfort and mobility are objectives of warminga person during the preoperative period and therapy is the objective ofwarming during one or more of the intraoperative and postoperativeperiods, it is presently necessary to use different warmingconfigurations. Manifestly, if one warming device could be used oradapted to be used perioperatively, significant savings in thermal carecould be realized.

SUMMARY OF THE INVENTION

In one aspect, a warming device includes a clinical garment having aninside surface supporting a convective thermal blanket.

In another aspect, a warming device includes a clinical garment and aconvective thermal blanket releasably attached to the inside of thegarment.

In yet another aspect, a convective thermal blanket is adapted to bereleased from a clinical garment used for preoperative warming in orderto be deployed for therapeutic warming intraoperatively.

BRIEF DESCRIPTION OF THE DRAWINGS

FIG. 1 is an illustration of a person wearing a warming deviceconstituted of a clinical garment and a thermal blanket mounted to theinside of the garment.

FIGS. 2A-2D are illustrations of full body, lower body, and upper bodyconvective thermal blankets.

FIGS. 3A and 3B are perspective assembly drawings of a warming deviceconstituted of a clinical garment and an upper body thermal blanketdisposed transversely across the inside of the garment.

FIGS. 4A-4D are perspective drawings showing assembly of a warmingdevice constituted of a clinical garment with flaps and an upper bodythermal blanket disposed transversely across the inside of the garment,between the flaps.

FIGS. 5A and 5B are perspective assembly drawings of a warming deviceconstituted of a clinical garment and an upper body thermal blanketdisposed longitudinally along the inside of the garment.

FIGS. 6A-6F are perspective drawings showing assembly of a warmingdevice constituted of a clinical garment with a lower hem and an upperbody thermal blanket disposed longitudinally along the inside of thegarment. FIGS. 6E and 6F also show a second thermal blanket disposedtransversely across the inside of the garment, over a portion of theupper body thermal blanket.

FIGS. 7A-7C are perspective drawings showing assembly of a warmingdevice constituted of a clinical garment with a lower hem and an upperbody thermal blanket disposed longitudinally along the inside of thegarment. FIGS. 7A and 7B also show a second thermal blanket disposedtransversely across the inside of the garment, between the lower hem andthe upper body thermal blanket.

FIGS. 8A and 8B are perspective drawings showing assembly of a warmingdevice constituted of a clinical garment and a thermal blanket disposedon the inside of the garment.

SPECIFICATION

A warming device is constituted of a clinical garment and at least onethermal blanket supported on an inside surface of the garment. In thisregard, a “clinical garment” is a garment that is typically used totemporarily clothe a patient in a clinical setting. Such garmentsinclude hospital gowns, robes, bibs and other equivalents. The clinicalsetting may be a medical or dental office or clinic, a hospital, or anyfacility or institution that provides medical or dental treatment topatients. The thermal blanket receives and distributes at least onestream of warmed pressurized air in a structure for being disposed on,adjacent, or next to the core and/or the limbs of a body. Whenpressurized with warmed air, the thermal blanket emits warmed airthrough one or more of its surfaces. The thermal blanket may bereleasably attached to the inside surface of the garment.

In one aspect, a warming device for perioperative use may be worn on aperson where it receives a stream of warmed pressurized air, distributesthe pressurized air within the attached thermal blanket, and emits theair through one or more surfaces of the thermal blanket to warm theperson's body. In another aspect, the warming device may be adapted fortherapeutic warming during surgery. In yet another aspect, the warmingdevice may be adapted for therapeutic warming by detaching the thermalblanket from the clinical garment for deployment intraoperatively. Inyet another aspect, the thermal blanket may be reattached to theclinical garment for further use on the same person during thepostoperative period. Various illustrative versions of the warmingdevice are illustrated and discussed in this specification.

In the warming device illustrated and discussed below, the thermalblankets are inflatable. That is, their structures, flaccid when not inuse, tauten when receiving a stream of pressurized air.

Refer now to the figures, in which a person 10 wearing a warming device12 for perioperative use is illustrated in FIG. 1. The warming device 12is constituted of a clinical garment 13 and at least one thermal blanket(not seen in this view) that is supported on an inside surface of theclinical garment 13. Further, the thermal blanket may be detachable fromthe garment. In this specification, the term “detachable” may also meanreleasable or separable. The thermal blanket receives warmed,pressurized air from a heater/blower unit (not seen in this view)through an air hose 14 with a nozzle 16 that is received in an inletport 17 of the thermal blanket. The inlet port may be accessed through aflap 18 in the garment.

Thermal blankets have been specifically designed for particulardeployments. Three representative thermal blankets are shown in FIGS.2A-2D. A “full body” thermal blanket 20 is shown in FIG. 2A. The fullbody thermal blanket is adapted to lie upon the person and to extendlongitudinally along the body of the person in order to coversubstantially the person's entire body, from near the ankles or feet upto the neck. A “lower body” thermal blanket 25 is shown in FIG. 2B. Thelower body thermal blanket 25 is adapted to lie upon the person and toextend longitudinally along the body of a person in order to cover theperson's lower body, from near the ankles or feet up to the waist orpelvis of the person. An upper body thermal blanket 30 is illustrated inFIGS. 2C and 2D. The upper body thermal blanket 30 has a bow-tie shapethat is adapted to lie upon and extend transversely across the upperbody of a person in order to cover the person's chest and extended arms.When fed a stream of warmed pressurized air, each of the thermalblankets 20, 25, 30 inflates and distributes the air within itself. Thepressurized air flows through apertures on the surface of the thermalblanket which faces the person. These thermal blankets may have one,two, or more inlet ports 38 through which an air hose provides warmedpressurized air from a heater/blower unit (not shown in these drawings).The construction of thermal blankets is well understood. Examples ofspecific constructions are given in the referenced Publication No. WO03/086500 and in U.S. Pat. No. 5,620,482, U.S. Pat. No. 5,443,488, U.S.Pat. No. 5,360,439, and U.S. Pat. No. 5,304,213.

The upper body thermal blanket 30 shown in FIGS. 2C and 2D is frequentlyused during thoracic, abdominal and pelvic surgery when a patient's corebody temperature can drop to hypothermic levels quickly. To prevent ormitigate the effects of hypothermia an upper body blanket is deployedfor therapeutic warming during the intraoperative period and may bedeployed during the postoperative period for therapeutic or comfortwarming. Preceding such surgery the patient may be treated with comfortwarming. If warmed preoperatively with one of the comfort warmingdevices described in the referenced Publication No. WO 03/086500, theclinical garment must be removed when the patient is moved to surgery inorder to maximize access to the surgical site. At the same time, anupper body thermal blanket must be unpackaged, made ready and deployed.A clinical garment may be indicated for postoperative warming. Similarconsiderations attend use of the lower body thermal blanket 25 forsurgery on the head, arm, face, or neck. Manifestly, a substantialconvenience and a significant reduction in cost would result fromperioperative use of a single warming device capable of providingcomfort warming preoperatively, therapeutic warming intraoperatively,and optional therapeutic or comfort warming postoperatively.

Such a warming device is constituted of a clinical garment and a thermalblanket supported on an inside surface of the garment. The thermalblanket may be permanently attached to the inside surface, or may beremovable therefrom. If the thermal blanket is removable, the warmingdevice may be further constituted of a mechanism acting between thegarment and the thermal blanket and adapted to detach the thermalblanket from the garment. With the thermal blanket attached inside thegarment, the device can be worn by the patient and comfort warming canbe provided. In preparation for surgery, the thermal blanket can be lefton the warming garment while the garment is folded over or around thethermal blanket so that the thermal blanket may be deployed on thepatient for therapeutic warming during surgery. In this case, theclinical garment may be unfolded to be again worn by the patient or toact as a blanket or drape while the patient is therapeutically warmedpostoperatively. Alternatively, the thermal blanket may be detached,removed, or otherwise separated from the garment and deployed on thepatient for therapeutic warming. In some instances if the thermalblanket is detached, the thermal blanket may be reattached to theclinical garment for further use postoperatively on the same patient. Inother instances, one or more additional thermal blankets can be providedinside the garment.

FIGS. 3A and 3B illustrate a warming device 40 for perioperative use.The warming device 40 is constituted of a clinical garment 42 with aninside surface 43, two opposing lateral hems 45, a lower hem 47, and alongitudinal axis 49. A thermal blanket is supported on the insidesurface 43. For example, the thermal blanket may be an upper bodythermal blanket 51 supported on the inside surface 43, transversely tothe longitudinal axis of the garment 42, for example, the thermalblanket may be releasably attached to the inside surface 43. Preferably,the upper body thermal blanket 51 is positioned in a lower portion ofthe inside of the garment 42, near or adjacent the lower hem 47. Anopening 54 in the garment 42 provides access by which an air hose canconnect to an inlet port of the upper body thermal blanket 51. Warmed,pressurized air flowing into the blanket exits through apertures in thesurface 55. The thermal blanket 51 may be a separate piece which isattached to the garment, or it may be formed integrally with the garmentin the manner disclosed, for example, in FIGS. 1D and 1E or FIGS. 3D-3Fof PCT publication WO 03/086500.

In FIGS. 3A and 3B, a mechanism to releasably retain the upper bodythermal blanket 51 as a separate element includes a plurality of islands52 of pressure sensitive adhesive material, hook and eye material,snaps, or other equivalent elements on the inside surface 43. Theislands 52 may be arranged in a pattern that lies on an outline of theperiphery of the upper body thermal blanket 51. Corresponding elementsare provided on the posterior surface of the upper body thermal blanket51 which faces the inside surface 43 of the garment in order to engagethe islands 52. With this construction, the upper body thermal blanket51 can be detached from the garment 42 by pulling it away from theinside surface 43. In this aspect, if the gown is needed for warmingduring the postoperative period, the thermal blanket may be reattachedto the garment by bringing the posterior surface of the thermal blanketagainst the pattern of islands on the inside surface 43.

In FIGS. 3A and 3B, a mechanism to releasably retain the upper bodythermal blanket 51 as an element formed integrally with the garmentincludes perforations, lines of weakness, or any equivalent structurethat allows the thermal blanket to be detached from the garment bytearing along the trace of the mechanism. Such a trace is indicated byreference numeral 60 in FIGS. 3A and 3B. With this construction, theupper body thermal blanket 51 can be detached from the garment 42 bytearing it away from the garment along the trace 60. In this case, thethermal blanket may be reattached to the garment by taping.

When worn as shown in FIG. 1, the warming device 40 of FIGS. 3A and 3Bretains warmed air within the clinical garment for comfort warmingpreoperatively. When the patient transitions to surgery, the upper bodythermal blanket 51 is detached from the garment 42 and deployed as shownin FIG. 2C for therapeutic warming. Postoperatively, the thermal blanket51 may be used alone for therapeutic heating or reattached to theclinical garment 42 for therapeutic or comfort heating.

FIGS. 4A-4D illustrate another aspect of the warming device 40 forperioperative use, constituted as described above in connection withFIGS. 3A and 3B, with exceptions to be described. In this case, it maybe that the emerging standard dimensions of the upper body thermalblanket will require adaptation of the form of the clinical garment.Typically, the length of the upper body blanket is 72 inches along thedimension shown in FIG. 2D, although the dimension may vary from 65inches to 75 inches. In order to accommodate this length, the structureof the clinical garment 42 includes two opposed flaps 62 formed in thelower portions of the two opposed lateral hems 45. The flaps 62 extendto the lower hem 47. A thermal blanket is supported on the insidesurface 43, and may be releasably attached to the inside surface 43. Forexample, the thermal blanket may be an upper body thermal blanket 51disposed on the inside surface 43, transversely to the longitudinal axisof the garment 42. The thermal blanket may be a separate piece which isattached to the garment, or it may be formed integrally with thegarment. Preferably, the upper body thermal blanket 51 is positioned ina lower portion of the inside of the garment 42, near the lower hem 47,extending from one flap 62 to the other. As best seen in FIGS. 4C and4D, in order to accommodate the length of the upper body blanket 51, theflaps are folded over the ends of the thermal blanket, against theinside surface 43 of the garment. The flaps are releasably retainedagainst the inside surface 43 by opposing islands 65 of pressuresensitive adhesive material, hook and eye material, snaps, or otherequivalent elements on the inside surface above and below the thermalblanket 51. An opening 54 in the garment 42 provides access by which anair hose can connect to an inlet port of the upper body thermal blanket51. Warmed, pressurized air flowing into the blanket exits throughapertures in the surface 55.

In FIGS. 4A-4D, a mechanism to releasably retain the upper body thermalblanket 51 as a separate element may include a plurality of islands ofpressure sensitive adhesive material, hook and eye material, snaps, orother equivalent elements as described above in connection with FIGS. 3Aand 3B. A mechanism to releasably retain the upper body thermal blanket51 as an element formed integrally with the garment includes thealternatives along the trace described above in connection with FIGS. 3Aand 3B. In this case, the thermal blanket may be reattached to thegarment by taping.

FIGS. 5A and 5B illustrate another aspect of the warming device 40 forperioperative use, constituted as described above in connection withFIGS. 3A and 3B, with exceptions to be described. In this case, theupper body thermal blanket 51 is supported on the inside surface 43,longitudinally, that is to say, in alignment with the longitudinal axis49 of the garment 42, and may be releasably attached to the insidesurface 43. Preferably, the upper body thermal blanket 51 issubstantially centered in the inside of the garment 42. The thermalblanket may be a separate piece which is attached to the garment, or itmay be formed integrally with the garment as described above inconnection with FIGS. 3A and 3B. An opening 54 in the garment 42provides access by which an air hose can connect to an inlet port of theupper body thermal blanket 51. Warmed, pressurized air flowing into theupper body thermal blanket 51 exits through apertures in the surface 55.A mechanism to releasably retain the upper body thermal blanket 51 as aseparate element may include a plurality of islands of pressuresensitive adhesive material, hook and eye material, snaps, or otherequivalent elements as described above in connection with FIGS. 3A and3B. A mechanism to releasably retain the upper body thermal blanket 51as an element formed integrally with the garment includes thealternatives along the trace 60 described above in connection with FIGS.3A and 3B. In this case, the thermal blanket may be reattached to thegarment by taping. When worn as shown in FIG. 1, the warming device 40retains the warmed air within the clinical garment for comfort warmingpreoperatively. When the patient transitions to surgery, the upper bodythermal blanket 51 is detached from the garment 42 and deployed as shownin FIG. 2C for therapeutic warming.

FIGS. 6A through 6F illustrate another aspect of the warming device 40for perioperative use, constituted as described above in connection withFIGS. 5A and 5B, with exceptions to be described. In this case, theupper body thermal blanket 51 is longitudinally disposed on the insidesurface 43, in alignment with the longitudinal axis 49 of the garment42, and may be releasably attached to the inside surface 43. Preferably,the upper body thermal blanket 51 is substantially centered in theinside of the garment 42. The thermal blanket may be a separate piecewhich is attached to the garment, or it may be formed integrally withthe garment as described above in connection with FIGS. 3A and 3B. Anopening 54 in the garment 42 provides access by which an air hose canconnect to an inlet port of the upper body thermal blanket 51. Warmed,pressurized air flowing into the upper body thermal blanket 51 exitsthrough apertures in the surface 55.

As best seen in FIGS. 6A and 6B, a mechanism to releasably retain theupper body thermal blanket 51 as a separate element may include aplurality of islands of pressure sensitive adhesive material, hook andeye material, snaps, or other equivalent elements as described above inconnection with FIGS. 3A and 3B. A mechanism to releasably retain theupper body thermal blanket 51 as an element formed integrally with thegarment includes the alternatives along the trace 60 described above inconnection with FIGS. 3A and 3B. In this case, the thermal blanket maybe reattached to the garment by taping.

The warming garment illustrated in FIGS. 6A through 6F may have itslength adjusted to accommodate the length of the upper body thermalblanket 51. In this regard, strips 70 of pressure sensitive adhesivematerial, hook and eye material, snaps, or other equivalent elements areattached longitudinally to the inside surface 43. The lower hem 47 maybe folded upwardly over the lower end of the upper body thermal blanket51 to the inside surface to be retained against the surface 43 by theaction of the strips 70 against themselves. This shortens the length ofthe garment 42 by the length of the folded section 72.

As shown in FIGS. 6E and 6F, a second thermal blanket 80 may bereleasably attached to the inside surface 43 of the garment over thefolded section 72. For this purpose, a plurality of islands 84 ofpressure sensitive adhesive material, hook and eye material, snaps, orother equivalent elements may be provided on the folded section 72 andthe inside surface 43. The islands 84 may be arranged in a pattern thatlies on an outline of the periphery of the thermal blanket 80.Corresponding elements may be provided on the posterior surface of thesecond thermal blanket 80 which faces the inside surface 43 and thefolded portion 72 in order to engage the islands 84. A second opening 86in the garment 42 provides access by which an air hose can connect to aninlet port of the second thermal blanket 80. Warmed, pressurized airflowing into the second thermal blanket 80 exits through apertures inthe surface 87.

When worn as shown in FIG. 1, the warming device 40 of FIGS. 6A through6F retains the warmed air within the clinical garment for comfortwarming preoperatively. In this case, the warmed air is provided throughthe second thermal blanket 80. When the patient transitions to surgery,the second thermal blanket 80 is detached from the clinical garment 42,the folded portion 72 is unfolded, and the upper body thermal blanket 51is detached from the garment 42 and deployed as shown in FIG. 2C fortherapeutic warming. Postoperatively, the thermal blanket 51 may be usedalone for therapeutic heating; alternatively, the upper body thermalblanket 51 or the second thermal blanket 80 may be reattached to theclinical garment 42 for therapeutic or comfort heating.

FIGS. 7A through 7C illustrate another aspect of the warming device 40for perioperative use, constituted as described above in connection withFIGS. 5A and 5B, with exceptions to be described. In this case, theupper body thermal blanket 51 is longitudinally disposed on the insidesurface 43, in alignment with the longitudinal axis 49 of the garment42. Preferably, the upper body thermal blanket 51 is substantiallycentered in the inside of the garment 42. The thermal blanket may be aseparate piece which is attached to the garment, or it may be formedintegrally with the garment as described above in connection with FIGS.3A and 3B. An opening 54 in the garment 42 provides access by which anair hose can connect to an inlet port of the upper body thermal blanket51. Warmed, pressurized air flowing into the upper body thermal blanket51 exits through apertures in the surface 55.

In FIGS. 7A through 7C, a mechanism to releasably retain the upper bodythermal blanket 51 as a separate element may include a plurality ofislands of pressure sensitive adhesive material, hook and eye material,snaps, or other equivalent elements as described above in connectionwith FIGS. 3A and 3B. A mechanism to releasably retain the upper bodythermal blanket 51 as an element formed integrally with the garmentincludes the alternatives along the trace 60 described above inconnection with FIGS. 3A and 3B. In this case, the thermal blanket maybe reattached to the garment by taping.

As shown in FIGS. 7A and 7B, a second thermal blanket 90 may bereleasably attached to the inside surface 43 of the garment between theupper body thermal blanket 51 and the lower hem 47. The second thermalblanket 90 is disposed transversely to the longitudinal axis 49 of thegarment 42 and has an indentation 92 to accommodate the lower end of theupper body thermal blanket 51. Preferably, the second thermal blanket isformed integrally with the garment 42. A second opening 96 in thegarment 42 provides access by which an air hose can connect to an inletport of the second thermal blanket 90. Warmed, pressurized air flowinginto the second thermal blanket 90 exits through apertures in thesurface 97.

When worn as shown in FIG. 1, the warming device 40 of FIGS. 7A through7C retains the warmed air within the clinical garment for comfortwarming preoperatively. In this case, the warmed air is provided throughthe second thermal blanket 90. When the patient transitions to surgery,the second thermal blanket 90 is detached from the clinical garment 42and then the upper body thermal blanket 51 is detached from the garment42 and deployed as shown in FIG. 2C for therapeutic warming.Postoperatively, the thermal blanket 51 may be used alone fortherapeutic heating; alternatively, the upper body thermal blanket 51 orthe second thermal blanket 90 may be reattached to the clinical garment42 for therapeutic or comfort heating.

FIGS. 8A and 8B illustrate another aspect of the warming device 40 forperioperative use, constituted as described above in connection withFIGS. 3A and 3B, with exceptions to be described. In this case, a lowerbody thermal blanket 101 is supported centered on the inside surface 43,aligned with the lower hem 47, and may be releasably attached to theinside surface 43. The thermal blanket 101 may be a separate piece whichis attached to the garment, or it may be formed integrally with thegarment as described above in connection with FIGS. 3A and 3B. Anopening 54 in the garment 42 provides access by which an air hose canconnect to an inlet port of the lower body thermal blanket 101. Warmed,pressurized air flowing into the lower body thermal blanket 101 exitsthrough apertures in the surface 105. A mechanism to releasably retainthe lower body thermal blanket 101 as a separate element may include aplurality of islands of pressure sensitive adhesive material, hook andeye material, snaps, or other equivalent elements as described above inconnection with FIGS. 3A and 3B. A mechanism to releasably retain thelower body thermal blanket 101 as an element formed integrally with thegarment includes the alternatives along the trace 60 described above inconnection with FIGS. 3A and 3B. In this case, the lower body thermalblanket 101 may be reattached to the garment by taping. When worn asshown in FIG. 1, the warming device 40 retains the warmed air within theclinical garment for comfort warming preoperatively. When the patienttransitions to surgery, the lower body thermal blanket 101 is detachedfrom the garment 42 and deployed as shown in FIG. 2B for therapeuticwarming.

The invention claimed is:
 1. A warming device for perioperative use,comprising: a clinical garment; a convective upper body thermal blanketattached to the inside of the clinical garment; the upper body thermalblanket including a surface and apertures in the surface through whichair flows in response to inflation of the upper body thermal blanket;the upper body thermal blanket having a shape to extend transverselyacross the upper body of a person to cover the person's chest andextended arms; and, a mechanism acting between the clinical garment andthe upper body thermal blanket and adapted to release the upper bodythermal blanket from the inside of the clinical garment.
 2. The warmingdevice of claim 1, wherein the upper body thermal blanket is disposedtransversely across the inside of the clinical garment.
 3. The warmingdevice of claim 1, wherein the mechanism includes lines of weakness inthe clinical garment near the perimeter of the upper body thermalblanket.
 4. The warming device of claim 1, wherein the mechanism is oneof hook and eye material, adhesive, or snaps.
 5. The warming device ofclaim 1, the clinical garment including opposed vertical hems, thewarming device further including: opposed flaps formed in the opposedvertical hems; the upper body thermal blanket extending from one flap tothe other flap; the flaps adapted to be folded into the inside of theclinical garment over the upper body thermal blanket; and means forreleasably retaining the opposed flaps against the inside of theclinical garment.
 6. The warming device of claim 5, wherein the meansinclude one of hook and eye material, adhesive, or snaps.
 7. The warmingdevice of claim 1, wherein the upper body thermal blanket is disposedlongitudinally along the inside of the clinical garment.
 8. The warmingdevice of claim 7, wherein the upper body thermal blanket is disposedlongitudinally along the middle of the inside of the clinical garment.9. The warming device of claim 7, wherein the mechanism includes linesof weakness in the clinical garment near the perimeter of the upper bodythermal blanket.
 10. The warming device of claim 7, wherein themechanism is one of hook and eye material, adhesive, or snaps.
 11. Thewarming device of claim 7, the clinical garment including a lower hem,the warming device further including: the lower hem adapted to be foldedinto the inside of the clinical garment over the upper body thermalblanket; and means for releasably retaining the lower hem against theinside of the clinical garment.
 12. The warming device of claim 11,wherein the means include one of hook and eye material, adhesive, orsnaps.
 13. The warming device of claim 11, further including: a secondthermal blanket attached to the clinical garment and disposedtransversely across the middle of the clinical garment on a foldedportion inside the clinical garment extending from the lower hem; andmeans for releasably retaining the second thermal blanket on the foldedportion.
 14. The warming device of claim 13, wherein the means includeone of hook and eye material, adhesive, or snaps.
 15. The warming deviceof claim 1, the clinical garment including a lower hem, the warmingdevice further including: a second thermal blanket attached to theinside of the clinical garment and disposed transversely across themiddle of the clinical garment between the lower hem and the upper bodythermal blanket; and means for releasably retaining the second thermalblanket on the inside of the clinical garment.
 16. The warming device ofclaim 15, wherein the means include one of hook and eye material,adhesive, or snaps.
 17. The warming device of claim 15, wherein thesecond thermal blanket is shaped to receive a portion of the upper bodythermal blanket.
 18. The warming device of claim 15, wherein themechanism includes lines of weakness in the clinical garment near theperimeter of the thermal blanket.
 19. The warming device of claim 15,wherein the mechanism is one of hook and eye material, adhesive, orsnaps.
 20. The warming device of claim 15, wherein the upper bodythermal blanket is disposed longitudinally along the inside of theclinical garment.
 21. The warming device of claim 20, wherein the upperbody thermal blanket is disposed longitudinally along the middle of theinside of the clinical garment.
 22. The warming device of claim 20,wherein the mechanism includes lines of weakness in the clinical garmentnear the perimeter of the thermal blanket.
 23. The warming device ofclaim 20, wherein the mechanism is one of hook and eye material,adhesive, or snaps.
 24. A perioperative warming device, comprising: aclinical garment; a convective upper body thermal blanket attached tothe inside of the clinical garment, longitudinally to the inside of theclinical garment; the convective upper body thermal blanket including asurface and apertures in the surface through which air flows in responseto inflation of the convective upper body thermal blanket; theconvective upper body thermal blanket having a shape to extendtransversely across the upper body of a person to cover the person'schest and extended arms; and means acting between the clinical garmentand the convective upper body thermal blanket for detaching theconvective upper body thermal blanket from the clinical garment.
 25. Thewarming device of claim 24, wherein the means include lines of weaknessin the clinical garment near the perimeter of the convective upper bodythermal blanket.
 26. The warming device of claim 24, wherein the meansis one of hook and eye material, adhesive, or snaps.
 27. A warmingdevice, comprising: clinical garment; a convective upper body thermalblanket attached to the inside of the clinical garment, longitudinallyalong the inside of the clinical garment; the convective upper bodythermal blanket having a shape to extend transversely across the chestand arms of a person to cover the person's chest and extended arms; andmeans acting between the clinical garment and the convective upper bodythermal blanket for detaching the convective upper body thermal blanketfrom the clinical garment.
 28. The warming device of claim 27, whereinthe means include lines of weakness in the clinical garment near theperimeter of the convective upper body thermal blanket.
 29. The warmingdevice of claim 27, wherein the means is one of hook and eye material,adhesive, or snaps.
 30. A warming device for perioperative use,comprising: a clinical garment with an inside surface; and at least oneconvective upper body thermal blanket attached to the inside surface;the convective upper body thermal blanket having a shape to extendtransversely across the upper body of a person to cover the person'schest and extended arms; and, the convective upper body thermal blanketincluding a surface and apertures in the surface through which air flowsin response to inflation of the convective upper body thermal blanket.31. The warming device of claim 30, further including means actingbetween the clinical garment and the at least one convective upper bodythermal blanket for detaching the convective upper body thermal blanketfrom the clinical garment.
 32. The warming device of claim 31, whereinthe at least one upper body thermal blanket is disposed transversely,across the inside of the clinical garment.
 33. The warming device ofclaim 31, wherein the at least one upper body thermal blanket isdisposed transversely across a lower portion of the inside of theclinical garment.
 34. The warming device of claim 31, wherein the meansinclude lines of weakness in the clinical garment near the perimeter ofthe convective upper body thermal blanket.
 35. The warming device ofclaim 31, wherein the means include one of hook and eye material,adhesive, or snaps.
 36. The warming device of claim 31, wherein theconvective upper body thermal blanket is disposed longitudinally alongthe inside of the clinical garment.
 37. The warming device of claim 1,wherein the clinical garment is a hospital gown.
 38. The warming deviceof claim 24, wherein the clinical garment is a hospital gown.
 39. Thewarming device of claim 27, wherein the clinical garment is a hospitalgown.
 40. The warming device of claim 30, wherein the clinical garmentis a hospital gown.